ANAMNESE PSICOLÓGICA

IDENTIFICAÇÃO PESSOAL

Data do atendimento: ___/____/_____

Nome:___________________________________________________________________

Idade: _____________ Sexo: __________________ Nacionalidade:__________________

Estado Civil: ______________________ Data de nascimento________________________

Grau de instrução:__________________________________________________________

Profissão: _______________________________________________________________

Residência (Cidade/Estado): _________________________________________________

Telefones para contado:_____________________________________________________

ATENDIMENTO:

Frequência:______________________________

Data/hora: ______________________________

a) Queixa Principal:
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b) Secundária:
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c) Sintomas:
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HISTÓRICO DA DOENÇA ATUAL:

a) Início da patologia:
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b) Frequência:
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c) Intensidade:
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d) Tratamentos anteriores:
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e) Medicamentos:
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HISTÓRICO PESSOAL:

a) Infância:
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b) Rotina:
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c) Vícios:
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d) Hobbies:
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e) Trabalho:
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HISTÓRICO FAMILIAR:

a) Pais:
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b) Irmãos:
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c) Cônjuge:
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d) Filhos:
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e) Lar:
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f) Patológica Pregressa (enfermidades e tratamentos atuais e anteriores):

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EXAME PSÍQUICO:

a) Aparência:
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b) Comportamento:
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c) Atitude para com o entrevistador:

( ) cooperativo ( ) resistente ( ) indiferente

d) Orientação:
( ) Autoidentificatória ( ) corporal ( ) temporal ( ) espacial ( ) orientado em relação a patologia

Observações:
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e) Atenção:

Vigilância: ______________________________________________________________________

Tenacidade: ____________________________________________________________________

f) Memória:
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g) Inteligência:
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h) Senso percepção:

( ) normal ( ) Alucinação

i) Pensamento:

( ) acelerado ( ) retardado ( ) fuga ( ) bloqueio ( ) prolixo ( ) repetição

* Conteúdo:

( ) obsessões ( ) hipocondrias ( ) fobias ( ) delírios

* expansão do eu:

( ) grandeza ( ) ciúme ( ) reivindicação ( ) genealógico ( ) místico, de

missão salvadora ( ) deificação ( ) erótico ( ) de ciúmes ( ) invenção ou

reforma ( ) ideias fantásticas ( ) excessiva saúde ( ) capacidade física ( )

beleza ( ) outros:
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* retração do eu:

( ) prejuízo ( ) auto-referência ( ) perseguição ( ) influência ( ) possessão

( ) humildades ( ) experiências apocalípticas ( ) outros:

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* negação do eu:

( ) hipocondríaco ( ) negação e transformação corporal ( ) autoacusação ( )culpa ( ) ruína

( ) niilismo ( ) tendência ao suicídio ( ) outros:
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j) Linguagem:
( ) disartrias (má articulação )
( ) afasias, verbigeração (repetição de palavras)
( ) parafasia (emprego inapropriado de palavras com sentidos parecidos)
( ) neologismo
( ) mussitação (voz murmurada em tom baixo)
( ) logorréia (fluxo incessante e incoercível de palavras)
( ) para-respostas (responde a uma indagação com algo que não tem nada a ver com o que foi
perguntado

k) Afetividade:
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l) Humor:
( ) normal ( ) exaltado ( ) baixa de humor ( ) quebra súbita da tonalidade do humor durante a
entrevista
 ANAMNESE PSICOLÓGICA

m) Consciência da doença atual:

( ) sim ( ) parcialmente ( ) não

HIPÓTESE DIAGNÓSTICA

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Vila Velha, __________________________ de__________.

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PRISCILA DE SOUZA LUCAS
CRP 16/6578